Adolescent Immunization in the Context of Adolescent Health: Insights from the Middle East

How can we better foster life-long immunization practices, particularly in adolescence? Recently the Sabin Vaccine Institute convened the first of three regional workshops to discuss issues related to adolescent immunization in the context of adolescent health. The first two-day interactive workshop was held in in Dubai, United Arab Emirates; additional workshops will be held in Asia and Latin America in 2018.

Twenty-six participants from across the Middle East and North Africa met to identify and discuss the challenges and opportunities related to health priorities among the region’s 125 million adolescents. The mortality rate among adolescents in the Middle East region is an estimated 115 deaths per 100,000 each year, second only to the African region. Adolescents in the region, particularly those living in low- and middle-income countries, face a range of challenges from increased exposure to adverse health behaviors to violence and armed conflict.

By bringing together health leaders from many sectors with immunization experts from 12 countries across the region, the workshop aimed to help participants identify tangible next steps to achieve the promise of adolescent immunization.

A consensus emerged in discussions that adolescent health has not received attention as a priority health issue in many countries in the region, and existing interventions are often dispersed and fragmented. Participants agreed that not only is adolescence a time when adolescent-specific health threats can be prevented but since many serious diseases in adulthood have their roots in adolescence, it is also a time to establish behaviors conducive to healthy adulthood. Participants noted that in the Middle East, in addition to lacking a platform, the adolescent health field faces several challenges, including limited evidence, lack of cross-sectoral coordination and competing health priorities.

Despite a long history of epidemiological surveillance in the region, participants noted that data are needed regarding the burden of vaccine-preventable diseases among adolescents. Existing adolescent health data are mainly from countries outside of the Middle East, which underscores the need for regional evidence generation. In addition, given the complexities of the region there was a recognition that there is very limited data on displaced and hard-to-reach adolescents, specifically those living in conflict areas. In terms of adolescent immunization, regional data on vaccine effectiveness, cost-effectiveness, and the longer-term health, social and economic impact of vaccine-preventable diseases in this age group are critical to the decision-making process for vaccine introduction.

Participants highlighted that the region has a strong Expanded Programme on Immunization, and that with an emphasis on better integration of health programs, national childhood immunization programs are well positioned to be a foundation for strengthening adolescent health services. For example, an adolescent health provider described how he utilizes vaccinations to routinely reach his adolescent patients for wellness checkups.

A lack of coordinated efforts between school-based interventions and health programs is a common experience. Greater collaboration between health providers, school programs and immunization services is needed to ensure that adolescent health priorities are being addressed through a multisectoral approach.

Previous efforts have focused on ensuring that adolescent health was placed on the global health agenda. Today, the focus has shifted to integrating and operationalizing adolescent health at the country level. The challenge faced by many countries is prioritizing interventions among the target population given the data gaps and fragmentation mentioned above and translating policy into practice. A discussion of how to set priorities led to an important point – adolescent health priorities and adolescent immunization priorities should not be in direct competition, but rather these programs should complement each other to reach more adolescents.

In 2018, Sabin will convene similar workshops to further explore adolescent health in Asia and Latin America. Sabin plans to publish conclusions and recommendations from the workshops, so that those who cannot participate can benefit from these important discussions and have the opportunity to implement proposed action items. Health care professionals and governments must have the appropriate data, policies and strategies in place to maximize adolescent vaccine coverage to prevent serious infectious diseases and their consequences.